Healthcare Provider Details

I. General information

NPI: 1154341337
Provider Name (Legal Business Name): CRAIG NEAL WILLIMANN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DWAYNE VONBEHREN DR
NEW HAVEN MO
63068-2251
US

IV. Provider business mailing address

100 DWAYNE VONBEHREN DR
NEW HAVEN MO
63068-2251
US

V. Phone/Fax

Practice location:
  • Phone: 573-237-2912
  • Fax: 573-237-2005
Mailing address:
  • Phone: 573-237-2912
  • Fax: 573-237-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number042562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: